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Wen-Shin Lee, Carson K Lam, Edward E Manche; Phototherapeutic Keratectomy for Epithelial Basement Membrane Dystrophy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1241. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Epithelial basement membrane dystrophy (EBMD) results in both visual disturbance due to corneal surface irregularity and pain due to recurrent erosions. Phototherapeutic keratectomy (PTK) is a commonly used therapeutic modality in the treatment of EBMD. This study evaluates the efficacy of PTK in treating both visual disturbance and recurrent erosions over long term follow up.
This study was a retrospective, non-randomized consecutive case series of 50 eyes of 44 patients with EBMD treated with PTK after failure of conservative medical treatment. Patients were treated between 2000 and 2012 with a minimum of 3 months of follow up. Preoperative and postoperative records were reviewed. Symptoms, clinical findings, uncorrected and best-corrected distance visual acuity were assessed.
Of the 50 eyes included in the study, 26 eyes presented with visual disturbance, 28 eyes presented with pain from recurrent erosions, and 4 eyes presented with both symptoms. For eyes presenting with visual disturbance, mean follow up was 42.2 months (SD 50.6), preoperative best corrected visual acuity (BCVA) was 0.22 on the LogMAR scale (SD 0.20, 95% CI 0.14-0.30), and post-operative BCVA was 0.06 (SD 0.12, 95% CI 0.01-0.11) (p = 0.0008). 77%, 19%, and 4% of patients had improved, unchanged, and worsened BCVA at final follow up respectively. Recurrence of visual disturbance occurred in 27% of patients (7 out of 26) at an average of 33 months postoperatively (SD 40.9 months). For eyes presenting with pain from recurrent erosions, mean follow up was 31.6 months (SD 39.5), pre-operative BCVA was 0.12 (SD 0.20, 95% CI 0.05-0.20), and post-operative BCVA was 0.05 (SD 0.16, 95% CI -0.01-0.12) (p = 0.16). 46%, 29%, and 25% of patients had improved, unchanged, and worsened BCVA at final follow up respectively. Recurrence of pain from erosions occurred in 32% of patients (9 out of 28) at an average of 12.2 months postoperatively (SD 14.1 months).
PTK is an effective treatment for both visual disturbance and pain from recurrent erosions in EBMD. For visual disturbance, PTK results in a significant improvement in BCVA compared to preoperative measurements that is sustained in the majority of patients over long term follow up. For pain from recurrent erosions, PTK effectively eliminates pain without recurrence in the majority of patients over long term follow up.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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